利尿剂在高血压治疗中的地位_West China Medical Journal

Authors：

 廖行 , 刘凯 ,  陈晓平

四川大学华西医院心脏内科（成都 610041）;

Corresponding author：

廖行, Email: 18180237207@163.com; 陈晓平, Email: xiaopingchen21@163.com

Keywords：

利尿剂; 高血压; 心血管事件; 新发糖尿病

DOI：

10.7507/1002-0179.20150510

Video：

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Abstract Full text Figures/Tables Video References Cited by

利尿剂一直作为降压治疗中不可或缺的一种药物，能显著降低心血管事件发生风险，然而其作为降压一线药物还是作为联合使用药物目前仍然存在争议。同时它对新发糖尿病、脂质代谢等方面的影响也不容忽视。现结合近年来发表的相关文献，对利尿剂在降压过程中的地位与困惑进行综述，从而为降压药的选择提供一定的参考。

Citation： 廖行, 刘凯, 陈晓平. 利尿剂在高血压治疗中的地位. West China Medical Journal, 2015, 30(9): 1779-1783. doi: 10.7507/1002-0179.20150510 Copy

1.	Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension[J]. Eur Heart J, 2013, 34(28):2159.
2.	李镒冲, 王丽敏, 姜勇, 等. 2010年中国成年人高血压患病情况[J]. 中华预防医学杂志, 2012, 46(5):409-413.
3.	Chobanian AV, Bakris GL, Black HR. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report[J]. ACC Curr J Rev, 2003, 12 (4):31-32.
4.	Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management:a European Society of Hypertension Task Force document[J]. J Hypertens, 2009, 27(11):2121-2158.
5.	Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly:a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents[J]. Circulation, 2011, 123(21):2434-2506.
6.	Grossman E, Angeli F, Verdecchia P, et al. Diuretics treatment of hypertension[J]. Diabetes Care, 2011, 34(2):315-317.
7.	Turnbull F, Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events:results of prospectively-designed overviews of randomised trials[J]. Lancet, 2003, 62(9395):1527-1535.
8.	王增武, 刘力生, 龚兰生, 等. 降压治疗与脑卒中二级预防:脑卒中后降压治疗研究[J]. 中华高血压杂志, 2010, 18(4):329-334.
9.	Party MW. Medical research council trial of treatment of hypertension in older adults:principal results. MRC working party[J]. BMJ, 1992, 304(6824):405-412.
10.	SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group[J]. JAMA, 1991, 265(24):3255-3264.
11.	PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack[J]. Lancet, 2001, 358(9287):1033-1041.
12.	Wing LM, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin-converting——enzyme inhibitors and diuretics for hypertension in the elderly[J]. N Engl J Med, 2003, 348(7):583-592.
13.	ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002, 288(23):2981-2997.
14.	Furberg CD, Wright JT, Davis BR, et al. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2000, 283(15):1967-1975.
15.	Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis[J]. JAMA, 1997, 277(9):739-745.
16.	Klungel OH, Heckbert SR, Longstreth WT Jr, et al. Antihypertensive drug therapies and the risk of ischemic stroke[J]. Arch Intern Med, 2001, 161(1):37-43.
17.	Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study:Intervention as a Goal in Hypertension Treatment (INSIGHT)[J]. Lancet, 2000, 356(9227):366-372.
18.	Wright JT, Probstfield JL, Cushman WC, et al. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses[J]. Arch Intern Med, 2009, 169(9):832-842.
19.	Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med, 2008, 358(18):1887-1898.
20.	Bolland MJ, Ames RW, Horne AM, et al. The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women[J]. Osteoporos Int, 2007, 18(4):479-486.
21.	Schoofs MW, Van Der Klift M, Hofman A, et al. Thiazide diuretics and the risk for hip fracture[J]. Ann Intern Med, 2003, 139(6):476-482.
22.	Reid IR, Ames RW, Orr-Walker BJ, et al. Hydrochlorothiazide reduces loss of cortical bone in normal postmenopausal women:a randomized controlled trial[J]. Am J Med, 2000,109(5):362-370.
23.	Aubin R, Ménard P, Lajeunesse D. Selective effect of thiazides on the human osteoblast-like cell line MG-63[J]. Kidney Int, 1996, 50(5):1476-1482.
24.	Aung K, Htay T. Thiazide diuretics and the risk of hip fracture[J]. Cochrane Database Syst Rev, 2011(10):CD005185.
25.	Marre M, Puig JG, Kokot F, et al. Equivalence of indapamide SR and enalapril on microalbuminufia reduction in hypertensive patients with type 2 diabetes:the NESTOR Study[J]. J Hypertens, 2004, 22(8):1613-1622.
26.	Gerc V, Buksa M. Arterial hypertension 2007:guidelines for the management of arterial hypertension[J]. Med Arh, 2007, 61(2 Suppl 1):27-30.
27.	Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease:meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies[J]. BMJ, 2009, 338(7705):b1665.
28.	Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients[J]. N Engl J Med, 2008, 359(23):2417-2428.
29.	Staessen A, Wang JG, Thijs L, et al. Cardiovascular prevention and blood pressure reduction:a quantitative overview updated until 1 March 2003[J]. J Hypertens, 2003, 21(6):1055-1076.
30.	Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs:a network meta-analysis[J]. Lancet, 2007, 369(9557):201-207.
31.	Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes:a quantitative review[J]. Hypertension, 2006, 48(2):219-224.
32.	Stump CS, Hamilton MT, Sowers JR. Effect of antihypertensive agents on the development of type 2 diabetes mellitus[J]. Mayo Clin Proc, 2006, 81(6):1637-1638.
33.	Kudoh T, Nagawaga T, Nakagawa I. Additional small amounts of diuretics improve blood pressure control at low cost without disadvantages in blood sugar metabolism[J]. Hypertens Res, 2008, 31(3):455-462.
34.	Kasiske BL, Ma JZ, Kalil RS, et al. Effects of antihypertensive therapy on serum lipids[J]. Ann Intern Med, 1995, 122(2):133-141.
35.	Wile D. Diuretics:a review[J]. Ann Clin Biochem, 2012, 49(5):419-431.
36.	Schmieder RE, Delles C, Messerli FH. Diuretic therapy and the risk for renal cell carcinoma[J]. J Nephrol, 2001, 13(5):343-346.
37.	Grossman E, Messerli FH, Goldbourt U. Does diuretic therapy increase the risk of renal cell carcinoma?[J]. Am J Cardiol, 1999, 83(7):1090-1093.

1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension[J]. Eur Heart J, 2013, 34(28):2159.
2. 李镒冲, 王丽敏, 姜勇, 等. 2010年中国成年人高血压患病情况[J]. 中华预防医学杂志, 2012, 46(5):409-413.
3. Chobanian AV, Bakris GL, Black HR. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report[J]. ACC Curr J Rev, 2003, 12 (4):31-32.
4. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management:a European Society of Hypertension Task Force document[J]. J Hypertens, 2009, 27(11):2121-2158.
5. Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly:a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents[J]. Circulation, 2011, 123(21):2434-2506.
6. Grossman E, Angeli F, Verdecchia P, et al. Diuretics treatment of hypertension[J]. Diabetes Care, 2011, 34(2):315-317.
7. Turnbull F, Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events:results of prospectively-designed overviews of randomised trials[J]. Lancet, 2003, 62(9395):1527-1535.
8. 王增武, 刘力生, 龚兰生, 等. 降压治疗与脑卒中二级预防:脑卒中后降压治疗研究[J]. 中华高血压杂志, 2010, 18(4):329-334.
9. Party MW. Medical research council trial of treatment of hypertension in older adults:principal results. MRC working party[J]. BMJ, 1992, 304(6824):405-412.
10. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group[J]. JAMA, 1991, 265(24):3255-3264.
11. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack[J]. Lancet, 2001, 358(9287):1033-1041.
12. Wing LM, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin-converting——enzyme inhibitors and diuretics for hypertension in the elderly[J]. N Engl J Med, 2003, 348(7):583-592.
13. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002, 288(23):2981-2997.
14. Furberg CD, Wright JT, Davis BR, et al. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2000, 283(15):1967-1975.
15. Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis[J]. JAMA, 1997, 277(9):739-745.
16. Klungel OH, Heckbert SR, Longstreth WT Jr, et al. Antihypertensive drug therapies and the risk of ischemic stroke[J]. Arch Intern Med, 2001, 161(1):37-43.
17. Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study:Intervention as a Goal in Hypertension Treatment (INSIGHT)[J]. Lancet, 2000, 356(9227):366-372.
18. Wright JT, Probstfield JL, Cushman WC, et al. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses[J]. Arch Intern Med, 2009, 169(9):832-842.
19. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med, 2008, 358(18):1887-1898.
20. Bolland MJ, Ames RW, Horne AM, et al. The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women[J]. Osteoporos Int, 2007, 18(4):479-486.
21. Schoofs MW, Van Der Klift M, Hofman A, et al. Thiazide diuretics and the risk for hip fracture[J]. Ann Intern Med, 2003, 139(6):476-482.
22. Reid IR, Ames RW, Orr-Walker BJ, et al. Hydrochlorothiazide reduces loss of cortical bone in normal postmenopausal women:a randomized controlled trial[J]. Am J Med, 2000,109(5):362-370.
23. Aubin R, Ménard P, Lajeunesse D. Selective effect of thiazides on the human osteoblast-like cell line MG-63[J]. Kidney Int, 1996, 50(5):1476-1482.
24. Aung K, Htay T. Thiazide diuretics and the risk of hip fracture[J]. Cochrane Database Syst Rev, 2011(10):CD005185.
25. Marre M, Puig JG, Kokot F, et al. Equivalence of indapamide SR and enalapril on microalbuminufia reduction in hypertensive patients with type 2 diabetes:the NESTOR Study[J]. J Hypertens, 2004, 22(8):1613-1622.
26. Gerc V, Buksa M. Arterial hypertension 2007:guidelines for the management of arterial hypertension[J]. Med Arh, 2007, 61(2 Suppl 1):27-30.
27. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease:meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies[J]. BMJ, 2009, 338(7705):b1665.
28. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients[J]. N Engl J Med, 2008, 359(23):2417-2428.
29. Staessen A, Wang JG, Thijs L, et al. Cardiovascular prevention and blood pressure reduction:a quantitative overview updated until 1 March 2003[J]. J Hypertens, 2003, 21(6):1055-1076.
30. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs:a network meta-analysis[J]. Lancet, 2007, 369(9557):201-207.
31. Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes:a quantitative review[J]. Hypertension, 2006, 48(2):219-224.
32. Stump CS, Hamilton MT, Sowers JR. Effect of antihypertensive agents on the development of type 2 diabetes mellitus[J]. Mayo Clin Proc, 2006, 81(6):1637-1638.
33. Kudoh T, Nagawaga T, Nakagawa I. Additional small amounts of diuretics improve blood pressure control at low cost without disadvantages in blood sugar metabolism[J]. Hypertens Res, 2008, 31(3):455-462.
34. Kasiske BL, Ma JZ, Kalil RS, et al. Effects of antihypertensive therapy on serum lipids[J]. Ann Intern Med, 1995, 122(2):133-141.
35. Wile D. Diuretics:a review[J]. Ann Clin Biochem, 2012, 49(5):419-431.
36. Schmieder RE, Delles C, Messerli FH. Diuretic therapy and the risk for renal cell carcinoma[J]. J Nephrol, 2001, 13(5):343-346.
37. Grossman E, Messerli FH, Goldbourt U. Does diuretic therapy increase the risk of renal cell carcinoma?[J]. Am J Cardiol, 1999, 83(7):1090-1093.

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利尿剂在高血压治疗中的地位

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